During a laparoscopic operation instruments with long handles are used in order to perform all steps of the operation. As a summary, the most important sewing-steps in a laparoscopic operation are the following: a first instrument holds the needle. The needle and the hanging thread are on one side of the tissues. With the help of the first instrument the needle is guided through the tissues that are to be sewn together. A second instrument receives the needle and then the first instrument releases the needle. The second instrument pulls the needle through the tissues so that the needle goes through from one side to a second side. The second instrument releases the needle and instead grips the thread at a suitable distance from the tissue on the second side. With suitable movements the thread is twisted around the first instrument. Then the first instrument grips the thread on the first side of the tissue. The first instrument pulls the end of the thread back so that a knot is created. Both instruments are pulled so that the tissues are brought together. A similar process is repeated two or more times so that at least three knots on each other are obtained so that the risk of them loosing the grip is minimized.
As understood from the above description, to make a knot during a laparoscopic operation is one of the most time-consuming parts of the operation. Limited possibilities of movement, two-dimensional viewing via a TV screen and the long handle in the instrument are some important factors that contribute to a higher degree of complexity. It is often that a knot may take more than ten minutes and the surgeon has to try several times before succeeding. Longer operation time is a large load for both the patient and the surgeon.
The applicant of the present invention has therefore developed a number of laparoscopic instruments that greatly facilitates a laparoscopic operation and thus shortens the operation time. These instruments are disclosed in the patent application, publication no. WO2007/073343. With the aid of these instruments both the entering of the thread through the tissues as well as the following knotting are handled much more easily than before. There is also described a method and a device where the ends of the thread through the tissue are brought together not by a knot but by a metal clip which is pressed by the device to secure the threads.
However, even if the step of bringing the ends of the thread together with the above mentioned instruments has been reduced compared to before, there is still room for improvements in this area.